Unit 2 - Sensory & Neuro assessment/stroke Flashcards
What does the external ear consist of? Think lets go out to “EAT”
- Auricle (pinna)
- External auditory canal
- Tympanic membrane (ear drum)
What is the role of the external ear?
The role is to collect and transmit sound waves to tympanic membrane.
What does the middle ear consist of?
- ossicles (malleus, incus, and staples) three small bones that are connected and transmit the sound waves to the inner ear
- Eustachian tube
- Mastoid/temporal bone
- Airspace in temporal bone
- Vibrations-> ossicles-> oval window.
What is the function of the ossicles in the middle ear?
- Three small bones that are connected and transmit the sound waves to the inner ear.
- Vibrations -> ossicles–> oval window
What is the function of the eustachian tube in the middle ear?
- A canal that links the middle ear with the back of the nose. The eustachian tube helps to equalize the pressure in the middle ear. Equalized pressure is needed for the proper transfer of sound waves. The Eustachian tube in lined with mucous, just like the inside of the nose and throat.
What does the inner ear consist of? Think- inside “CVS”
- Cochlea- This contains the nerves for hearing
- Vestibule- This contains receptors for balance.
- Semicircular canals- This contains receptors for balance
What is Cranial Nerve VIII (8) and what is its role?
Known as the Auditory (vestibulocochlear) its role is hearing and balance
How can hearing loss affect a patient?
- Ineffective communication
- Decreased interaction
- Withdrawal
- Suspicion
- Loss of self-esteem and security
What parts of the ear is affected by conductive hearing loss?
Outer and middle ear
What causes conductive hearing loss?
Sound waves are blocked to the inner ear fibers
What are the signs and symptoms of conductive hearing loss
Patient hears better in noisy environments
How do you treat conductive hearing loss?
- Fix the direct problem (blockage)
- Hearing aid
Is conductive hearing loss preventable? How?
Yes, monitor and evaluate for problems and treat
Is conductive hearing loss permanent?
- Majority of the time no, the exception is when it is caused by tumors that cause damage or damage related to surgery scar tissue.
What parts of the ear is affected by sensorineural hearing loss?
Inner ear damage (nerve pathways)
What causes sensorineural hearing loss?
Damage to the inner ear structures, damage to CN VIII (8) or the brain itself, prolonged exposure to loud noises, medication, trauma, inherited problems, metabolic circulatory problems, infections, surgery, Minieres, DM, Myxedema, aging (presbycusis)
How do you treat sensorineural hearing loss?
- Depends on the problem
- Mediation
- Surgery
Is sensorineural hearing loss permanent?
Yes, most common type of permanent hearing loss. There is NO cure!! When damage to the nerve pathways occur it cannot be fixed
Is sensorineural hearing loss preventable? How?
- Ototoxicity (if caught early)- Is preventable if caught early and medication is discontinued immediately.
- Listening to loud music– Avoid listening to loud music can prevent hearing loss
Ototoxicity and loud music are the ONLY preventable causes of sensorineural hearing loss.
What are the signs and symptoms of sensorineural hearing loss?
- Hearing deficit and balance problems
- If caused by Meniere’s disease: Vertigo and Tinnitus
What medications can cause Ototoxicity? List 6
- Aspirin
- Cisplatin (Cancer med)
- Furosemide
- Gentamycin
- Quinine (anti-malaria medication)
- Vancomycin
What parts of the ear is affected by mixed hearing loss?
- Outer
- Middle
- Inner
What causes mixed hearing loss?
A mix of causes associated with both conductive and sensorineural damage
What are the main functions of each cranial nerve
- I Olfactory: smell
- II optic: Visual acuity
- III Oculomotor: Opening of eyelid/eye movement
- IV Trochlear - eye movement
- V Trigeminal: Facial sensation, chewing movements
- VI Abducens: Eye movement
- VII Facial: Facial muscle movements, and eyelid closing
- VIII Auditory (vestibulocochlear): Hearing and balance
- IX Glossopharyngeal: Taste on posterior 3rd of tongue
- X Vagus- Uvula (palate muscle) and swallowing
- XI Accessory: Shoulder shrug
- XII Hypoglossal- Tongue movement.
What is tinnitus and how does tinnitus affect the patient?
- Ringing of the ears
- Grief and depression (suicidal ideation)
What is Vertigo? How does vertigo affect the patient?
- Room Spinning while still because of the fluid in the ears or compression CN VIII (8)- “hearing and balance”
What are patients with vertigo most at risk for?
Falls
What is the weber’s test?
Detects unilateral hearing loss
What is the Rinne’s test?
Compares air conduction with bone conduction
What is Meniere’s disease?
Dilation of endolymphatic system by over production or decreased reabsorption of endolymphatic fluid
What causes Meniere’s disease?
Any factor that increases endolymphatic secretion in the labyrinth, viral and bacterial infections, allergic biochemical and vascular disturbance, changes in the microcirculatory in the labyrinth, long term stress
What are the clinical manifestations/signs and symptoms for Meniere’s disease?
Fullness in the ear, tinnitus, vertigo, n/v, nystagmus, severe headache
What interventions should the nurse focus on for a patient with Meniere’s disease?
- Safety measures
- Enviromental control
- Surgery
- Post-op interventions
How is Meniere’s disease treated?
- Medication/symptom management
- Surgery
- Stunt
- Resection of CN8 or total resection of labyrinth
Nursing care of hearing loss? What are the eight important key factors for caring for a patient with a hearing deficit?
- Assessment= early detection
- Safety measures (due to loss of hearing)
- Dietary (nutrition, hydration)
- Medication
- Surgery (ex. cochlear devices)
- Hearing aids
- Community services
- Community techniques
- Communication techniques
Why is assessment of our patient an important key factor in caring for a patient with hearing deficits?
- You want to make sure that you are assessing your patient for hearing loss. Remember for sensorineural hearing loss can lead to permanent hearing loss so we want to try and prevent any further damage
Why is safety measures an important key factor for caring for a patient with a hearing deficit?
It is important to educate patients and have them teach back to you to ensure that they understand. Also, make sure to educate the patient to check both ways before they cross the street and always be aware of there surroundings because they might not be able to hear a vehicle coming etc.
Why is dietary an important key factor for caring for a patient with a hearing deficit?
Ensures that the patient has adequate nutrition and hydration to ensure that their oil and sebaceous glands can properly maintain their hearing.
Why is community resources and hearing aids an important key factor for caring for a patient with a hearing deficit?
- Important to educate patients on how to maintain their hearing aids (how to change batteries, have back up batteries, and how to properly store)
- Hearing aids are expensive so we can give patients community resources to help get hearing aids because the majority of insurances companies wont cover them as they are seen as a necessity
Why is communication techniques an important key factor in caring for a patient with a hearing deficit?
You never want to shout or yell at a patient to get them to hear you. You want to talk low and slow directly next to a patient. Many patients have adapted to reading lips along with hearing. LOW and SLOW. If the patient still can not hear you, you can try and write out what you are saying if the patient can read on the white board or piece of paper.
What are some specific safety measures and environmental control interventions you could focus on for a patient with meniere’s?
- Prevent injury during vertigo attacks (fall bundle)
- Provide bed rest in a quiet environment
- Provide assistance walking
- Instruct patient to move their head slowly to prevent worsening of the vertigo
- Initiate a sodium and fluid restrictions as prescribed
- Instruct the patient to stop smoking
- Instruct the patient to avoid watching tv because of flickering of lights may exacerbate symptoms, allow the patient to rest
- And control vertigo N/V, mild diuretics may also be prescribed to decrease endolymph fluid
- Inform the patient about vestibular rehab as prescribed
What are some specific surgical and post- op interventions you focus on for a patient with Meniere’s?
- Surgery- Teach the patient that surgery is performed when medical therapy is ineffective, and the functional level of the patient has decreased significantly. Insertion of shunt may be an option early in the course of the disease to assist with the drainage of excess fluids. A resection of the vestibular nerve or total removal of the labyrinth may be performed.
- Post-operative interventions- packing and dressing on the ear. Speak to the patient on the side of the UNAFFECTED ear. Perform neuro assessments. maintain safety. Assess when ambulating. Encourage the patient to use a bedside commode rather than ambulating to the bathroom. Administer antivertigo and anti emetic medications as prescribed
What is the process of administering eye drops?
- Apply to conjunctive sac
- Light amount of pressure to the canthus (nasolacrimal duct) to avoid a systemic effect
What are the four leading causes of blindness?
- Age related macular degeneration
- Cataracts
- Diabetic retinopathy
- Glaucoma
What is the aqueous humor? What is it made of? Where is it made? What is its fuction?
- 99.9% water and 0.1% sugar, vitamins, proteins
- The aqueous humor helps maintain intraocular pressure, transports Vitamin C to and from the segment and acts as an antioxidant
What is the normal flow of aqueous humor?
- Posterior chamber to
- Anterior chamber to
- Canal of schlemm to
- Trabecular meshwork
What is vitreous humor? What is it made of? What is its function?
- 99% water
- 1% collagen
- The function is to keep the shape of the eye
Cranial nerves that affect the eye? What are their functions?
- II Optic-Visual Acuity
- III- Oculomotor- opening of eyelids/eye movement
- IV Trochlear- eye movement
- VI Abducens- Eye movement
- VII Facial- Facial muscle movements and eye lid closing
What are cataracts?
Opacification of the lens. As the lens age fibers and proteins change. They will begin to clump together causing opacification of the lens. As the lens becomes opaque the patients visions will become blurred, foggy or fuzzy.
What are the risk factors/causes that attribute to cataracts?
- Age related (regardless of health you become at risk as you age) **
- Congenital
- Secondary to DM, UV light, Corticosteriods
- Trauma
What are the clinical manifestations/ signs and symptoms of cataracts?
- Opaque lens
- Blurred vision
- Foggy or fuzzy vision
- Decreased visual acuity
- No pain
- Occurs gradually
- Decreased night vision
What are the treatment options for cataracts? How do you “cure” cataracts?
- Surgery is the only “cure”
- You can suggest visual aids (change in RX, reading glasses, magnifiers, increase lighting, adjust life style)
What do the three phases involve for surgical intervention of cataracts? (summarize each phase)
- pre-op
- Intra-op
- Post-op
What should the nurse do if the patient has complications after cataract surgery?
- Notify the surgeon of health care provider immediately.
What is glaucoma? Where is the initial visual loss going to occur.
- Disturbance of the functional/structural integrity of the optic nerve.
- Increase of intraocular pressure.
- Peripheral
What is closed-angle glaucoma? Clinical manifestations? treatment?
- Increase IOP that rise is sudden
- Fluid builds in the posterior chamber and directly affects the optic nerve
- Can cause irreversible damage to the optic nerve with 1-2 days.
- EMERGENCY!!!
What are some other names that closed angle glaucoma might be called?
- Narrow angle glaucoma
- Congestive glaucoma
- Pupillary closure glaucoma
What is open-angle glaucoma? Clinical manifestations?
- Outflow is decreased— Fluid build up in anterior portion of the eye in front of the lens.
2.manifestations can include halo seen around light, loss of peripheral vision, and headaches.
What are beta-adrenergic blocking agents and what are their functions?
- Lower IOP by reducing production of aqueous humor.
What are timolol contraindications? Adverse reactions? Patient teaching for home use/precautions?
- Contraindications: Asthma, COPD, Sinus Bradycardia, Heart failure, 2nd/3rd degree block.
- Bronchospasm, dyspnea, Bradycardia, dizziness, heart block
What is macular degeneration? Where is the initial visual loss going to occur? When you are going over the discharge paperwork with the patient where will you want to stand to talk to the patient?
- Degeneration of macula in back of the eye along forveacentrails
- Side of bed.
3.central vision loss
Clinical manifestations for DRY macular degeneration? Is there a cure? Patient teaching?
- Develops gradually
- Need for brighter light
- Gradual haziness of central or overall vision
- Blurred spot in the center of field of vision
- No cure, only slowing of progression
- Antioxidants, zinc, and selenium (vit. A, C, & E)
- Diet- fruits, vegetables, fish w/omega 3 fatty acids
Clinical manifestations for WET macular degeneration? Is there a cure? Patient teaching?
- Abrupt onset
- Rapid worsening & Vision loss
- Well-defined blurry/blind spot of central vision
- No cure, only slowing of progression
- Injections into eye/laser
- Photodynamic therapy
What is open-angle glaucoma?
Primary open angle glaucoma also known as chronic glaucoma or wide angle glaucoma. It is the MOST COMMON type of glaucoma and it has a gradual onset. Primary open angle glaucoma refers to the angle between the iris and the sclera. The aqueous humor outflow is decreased due to the blockages in the eyes drainage system (the canal of Schlemm and trabecular meshwork) causing a gradual rise in intraocular pressure.